Impact of the COVID-19 pandemic on the delivery of newborn circumcision care
Lauren Elizabeth Corona, MD1, Ilina Rosoklija, MPH1, Ryan F. Walton, BS1, Derek J. Matoka, MD1, Catherine M. Seager, MD1, Jane L. Holl, MD, MPH2, Emilie K. Johnson, MD, MPH1.
1Lurie Children's Hospital, Chicago, IL, USA, 2University of Chicago, Chicago, IL, USA.
Background:Over half of boys in the United States undergo circumcision, a procedure that has its greatest health benefits and lowest risks when performed during the newborn period under local anesthesia. The COVID-19 pandemic has affected delivery of patient care in many ways, but little is known about how the pandemic influenced newborn circumcision care. We sought to ascertain physician perspectives on providing newborn circumcision care, with the goal of informing solutions to optimize access to desired newborn circumcision. This study aimed to describe COVID-19 pandemic related barriers and changes that emerged during more general interviews about newborn circumcision.
Methods:We performed semi-structured interviews with perinatal physicians between April and July 2020 in the Greater Chicago Area to learn about their experiences with providing newborn circumcision care. Participants completed a brief demographic survey after the interview, and responses were summarized. Interviews were transcribed verbatim and qualitative coding performed. Codes were summarized into themes, with representative quotes. Although not specifically included in the interview guide, pandemic-related changes around providing newborn circumcision care was a theme that emerged and was subsequently explored further.
Results:Twenty-three perinatal physicians (10 family medicine, 8 pediatricians, and 5 obstetricians) from 11 Chicago-area hospitals were interviewed. Nearly half of physicians (44%) identified that the COVID-19 pandemic affected delivery of newborn circumcision care. Changes that occurred due to the pandemic are included in the Table with frequencies and representative quotes. The most commonly mentioned COVID-19 related changes were: 1) delays secondary to systems/processes changes, 2) staffing/proceduralist related changes, and 3) changes in procedural setting.
Conclusions:Physicians who were interviewed about newborn circumcision during the beginning of the pandemic identified COVID-19-related changes as a barrier to care delivery. This was an unanticipated, albeit not surprising finding of a larger study aimed at identifying disparities in access to desired newborn circumcision. The COVID-19 crisis resulted in a multitude of rapid changes in many aspects of medical care, including the provision of newborn circumcision. Identifying COVID-19 pandemic-related barriers, their implications, and solutions may facilitate a more comprehensive understanding of barriers to newborn circumcision in general, as well as contribute to future care improvement strategies.
|Themes related to changes in newborn circumcision care secondary to the COVID-19 pandemic|
|Delays secondary to systems/processes changes||6||"I think, you know, everyone who is designated to be doing the circs [during COVID] are also designated to be covering actively laboring patients, so it depends… so, obviously, actively laboring or OB triage patients have to come first. So, sometimes the timing [of circumcision] gets pushed off."|
|Staffing/proceduralist related changes||6||"…now that COVID is going on, um, our family medicine has been pulled out to be more in the clinic. So, the OBs are doing all of them."|
|Changes in procedural setting||4||"…since the pandemic, we haven’t been doing them in the office."|
|Changes in procedural logistics/support||3||"I tell them if they want the circumcision done, they’re going to have to wait until the baby is at least twenty-four hours and also during a reasonable time because I’m not going to do circumcisions at like six pm."|
|Provider practice changes||2||"And then in the outpatient setting, I have two clinics a week, which-now one of them is just telemedicine because of COVID."|
|Changes in parental counseling||1||"So, they were like, ‘no, you don’t need it. It’s elective.’"|
|Acceleration of previously planned changes to systems||1||"We had planned to change to inpatient in May anyway…so COVID came and we just switched early."|
|Changes in patient demographics||1||"…and especially during COVID, it’s been a much larger percentage of Hispanic patients." –|
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